Provider Demographics
NPI:1366744922
Name:O'MALLEY CHIROPRACTIC HEALTH CENTER, LLC
Entity type:Organization
Organization Name:O'MALLEY CHIROPRACTIC HEALTH CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:O'MALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-257-9400
Mailing Address - Street 1:78 BEAVER ROAD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109
Mailing Address - Country:US
Mailing Address - Phone:860-257-9400
Mailing Address - Fax:860-257-7169
Practice Address - Street 1:78 BEAVER ROAD
Practice Address - Street 2:SUITE 2A
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109
Practice Address - Country:US
Practice Address - Phone:860-257-9400
Practice Address - Fax:860-257-7169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT000731111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT519710OtherAETNA
CT050000731CT01OtherANTHEM BC/BS
682637OtherCONNECTICARE
CT050000731CT01OtherANTHEM BC/BS
682637OtherCONNECTICARE